Individual
DR. JORGE LUIS GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL CENTER DRIVE, LEBANON, NH 03753
(603) 650-7215
(603) 650-7214
Mailing address
PO BOX 659, LEBANON, NH 03766
(603) 650-7215
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
9079
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0RE2924
—
VT
05
—
80002924
—
NH
Enumeration date
07/05/2006
Last updated
07/08/2007
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